Insurance Claims Intake Agent

An insurer has a 30,000-claim backlog. Leadership wants AI to clear it. Most claims stall because documents are missing; decisions on payouts are regulated and must stay with adjusters.

• 1Why is each claim in the backlog stuck?
• 2Which claim types and values dominate?
• 3What must legally be decided by a person?
• 4Where do documents arrive (email, portal, post)?
• 5How are fraud referrals made today?

• Payout decisions must be made by licensed adjusters
• Full audit trail for regulators
• Customer communications must be approved templates
• Personal and health data in claims

• Document classification and field extraction
• Completeness check against claim type
• Drafted customer request for missing items, approved by an adjuster
• Claim summary for adjusters
• Shadow-mode evaluation on historical claims